Abstract: Toward a Better Understanding of the Decision to Register to Become an Organ Donor: Lessons for Campaigns

◆ Thomas Hugh Feeley, University at Buffalo, SUNY
◆ Stephanie Gillis, University at Buffalo, SUNY

Health communication campaigns seeking to increase the percentage of Americans who register their consent to donate have met with mixed success in published papers. Efforts that do not allow for immediate registration have proven less effective than efforts that provide an immediate opportunity to donate. This finding indicates the messaging used in campaigns does not overcome the attitudes of many unregistered individuals. The current study sought to better understand the attitudes and beliefs of Americans toward the concept of registering to become a deceased organ donor through motor vehicles’ transactions. A national survey was conducted toward the goal of better understanding Americans’ reluctance to register consent for deceased organ donation. The choice architecture of the motor vehicles’ form was first examined by comparing each state’s donor designation rate with the method of asking the registration question. Through a national survey using the MTurk survey pool (n = 250), individuals’ attitudes toward donation, registration status and estimates of the believability of registration percentages were measured. In addition, open-ended reasons for registering or not registering were reported by participants. Fifty-five percent (55%) of respondents reported as male, 69% had a college degree or graduate degree and participants represented the five regions of the USA. The findings provide insight into decision-making in this context and reveal novel findings in relation to the over 50% of respondents who self-reported they have yet to register their consent. Three findings emerged from survey data. First, the oft-cited claim that Americans are generally supportive of deceased donation was not supported when using a more nuanced measure of individual attitudes toward donation compared to the single-item measure fielded in Gallup polls. Second, when asked the percentage of Americans who are represented on the national registry, 25% of those registered did not believe one-half of the country is registered and 49% of those unregistered did not believe this statistic. This finding indicates the social norms approach to shaping beliefs toward registration may not be effective to unregistered Americans. Third, the reasons provided for not registering suggest campaigns to promote the registry must overcome both negative attitudes, fears about donating, and a lack of understanding what it means to register one’s intent. In terms of health communication efforts going forward, messaging should be prepared for addressing misinformation and allaying unfounded misunderstandings among the general population about the organ allocation process and the position of major religions regarding donation. The current findings have important implications for organizations seeking to promote organ donation through mass media and through office-based interventions in motor vehicle bureaus.